The prediction of treatment outcomes by early maladaptive schemas and schema modes in obsessive-compulsive disorder.

Anne Katrin Külz,Brunna Tuschen-Caffier,Christoph Nissen,Ellen Gross,Nicola Thiel,Nirmal Herbst,Elisabeth Hertenstein,Ulrich Voderholzer

doi:10.1186/s12888-014-0362-0

Anne Katrin Külz, Brunna Tuschen-Caffier + Show 6 more

Open Access

https://doi.org/10.1186/s12888-014-0362-0

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Abstract

BackgroundHigher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls. This study examines the relationship of EMS and schema modes to OC symptom severity and the predictive value of EMS and schema modes on treatment outcome in inpatients receiving Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). The main assumption was a negative association between the EMS of the domain ‘disconnection’ and dysfunctional coping and parent schema modes and the treatment outcome.MethodsEMS, schema modes, depression and traumatic childhood experiences were measured in 70 patients with OCD. To analyze the predictors, two regression analyses were conducted considering multiple variables, such as depression, as covariates.ResultsRegression analyses demonstrated that higher scores on the EMS named failure and emotional inhibition and depressive symptom severity at pretreatment were significantly related to poor outcome and explained a high percentage of the variance in OC symptoms at posttreatment. No influence on the treatment outcome was observed for schema modes, other EMS or other covariates.ConclusionsThe results support the approach to extend the CBT with ERP treatment with therapeutic elements focusing on maladaptive schemas, particularly in non-responders.

Highlights

Higher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls
Hypothesis 2: Higher levels of EMS and schema modes in the non-responder than in the responder group Analyses with paired sample t-tests showed a significant reduction of obsessive-compulsive symptoms (T = 10,006; df = 67; p < 0.001) in the YaleBrown Obsessive-Compulsive Scale (Y-BOCS) from pre- (M = 24, sd = 6.2) to posttreatment (M = 14.6, sd = 7.0)
The mean Y-BOCS reduction was 37,5%, indicating a positive outcome of the Exposure and Response Prevention (ERP) and pharmacotherapy treatment, as a symptom reduction of 35% in the literature is designated as treatment response [3]

Summary

Introduction

Higher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls. This study examines the relationship of EMS and schema modes to OC symptom severity and the predictive value of EMS and schema modes on treatment outcome in inpatients receiving Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is the first-line treatment for OCD according to standard guidelines [2,3,4,5,6,7]. Cognitive interventions that have been effective in the treatment of depression and anxiety disorders were adapted to a CBT model addressing typical dysfunctional assumptions in OCD, such as inflated responsibility, perfectionism, overestimation of threat and intolerance of uncertainty [13,14,15,16,17,18]. Aaron Beck [19] assumed that negative and stressful experiences during childhood may lead to the consolidation of maladaptive core beliefs in individuals, so-called

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